title: Total elbow arthroplasty for acute distal humeral fractures in patients over 65 years old - results of a multicenter study in 87 patients.
abstract: BACKGROUND
  Fractures of the distal humerus represent 5% of osteoporosis fragility fractures in subjects over the age of 60. Osteoporosis, comorbidities and intra-articular comminution make management of this entity difficult.
  
  
  OBJECTIVE
  The hypothesis was that total elbow arthroplasty could be a reliable treatment option in subjects over the age of 65 presenting with a fracture of the distal humerus.
  
  
  METHODS
  Eight-seven patients (80 women and 7 men) mean age 79 years old (65-93) underwent total elbow arthroplasty for the treatment of an AO type A fracture in 9 cases, type B in 8 and type C in 70.
  
  
  RESULTS
  After a mean follow-up of 37.5 months (6-106) the Mayo Elbow Performance Score MEPS was 86±14, the quick-DASH score was 24±19 and the Katz score was 5±1.5 points. The MEPS was better in patients with a high preoperative Katz score and a history of inflammatory arthritis who were living at home. Fifty-five patients (63%) presented with a pain-free elbow, and 20 (24%) with slight pain. The flexion-extension range of motion was 97±22° and 48% presented with a flexion-extension arc of at least 100°. Function was normal in 69 patients. Complications were identified in 20 cases (23%) and revision surgery was necessary in 8 (9%). Two arthroplasties had to be changed, one for a fracture of the humeral stem component and the other for loosening. Only one infection occurred in this series.
  
  
  CONCLUSIONS
  Total elbow arthroplasties provide fractured patients with immediate satisfactory results and a stable, painless and functional elbow. These results seem to be reliable and durable. The rate of complications is low with revision surgery in approximately 10%.
  
  
  METHODS
  Level IV.
authors.affiliation: Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, CHU Purpan, place du Dr-Baylac, 31059 Toulouse, France. Electronic address: mansat.p@chu-toulouse.fr.
authors.forename: P
authors.initials: P
authors.lastname: Mansat
authors.forename: H
authors.initials: H
authors.lastname: Nouaille Degorce
authors.forename: N
authors.initials: N
authors.lastname: Bonnevialle
authors.forename: H
authors.initials: H
authors.lastname: Demezon
authors.forename: T
authors.initials: T
authors.lastname: Fabre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods*; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018460:Fractures, Comminuted / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000601:surgery*; D008297:Male; D010024:Osteoporosis / Q000150:complications*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D016896:Treatment Outcome
keywords: Distal humerus fracture; Osteoporosis; Total elbow arthroplasty